July 2015

Apr 20, 2014

The plan was that states would expand Medicaid coverage to more uninsured people, and hospitals would offset some of their reduced revenue through the increased volume of patients paid for by Medicaid. But North Carolina has not expanded Medicaid coverage, which means Cone Health and others are being paid less while still caring for the nearly 80,000 uninsured in Guilford County alone.

This has had an impact on access to health care in our immediate area. For example, Triad Adult and Pediatric Medicine closed a major clinic that provided care for adults and reduced services for infants and children. Our response to the loss of this vital service was to partner with our pediatric teaching service to open Cone Health Center for Children, which will help care for nearly 40,000 uninsured children in our community. We plan to open a facility for adults later this spring. Still, the numbers are daunting. Cone Health provided $245 million last year in care for which we didn’t get paid. That’s nearly $60 million more than the year before. How can we keep that up?

And of course the human costs are even higher than the financial ones.

Greensboro is fortunate to have a strong, locally-controlled health system (disclosure: I am still on its board) and to have had Tim Rice running the show during tumultuous times.

Read the whole article for a sense of the issues facing hospitals -- the two-midnight rule is another tough one -- and some of the local responses to them.

Comments

"We just cannot continue to do what we have been doing." And yet, that has been the position of the naysayers - repeal and replace with what got us to the most costly, fragmented and inefficient health care system in the world. Health care is similar to national defense in that free markets are not effective addressing a system consisting primarily of overhead with a large portion fixed cost, and significant expenditures paid with federal resources.

How do the salaries of the highest-paid doctors compare with doctors at other, similarly-sized regional healthcare systems?

How much do similar RHSs charge for an aspirin or an MRI?

Relative to total patient population, how many patients have other, comparable RHSs sent to bankruptcy in the past 10 years?

I don't know the answers but would love to. My point, however, is that numbers absent context are meaningless. You seem to be implying that Cone Health is an egregious offender, when, as Pfknc pointed out, the entire health-care system has problems that the ACA is only beginning to address.

George Hartzman, aka WTF, can you comment on the ethics of a newspaper columnist joining public conversations under a pseudonym? Jeff Sykes, does this conform to Yes! Weekly standards?

Lex deals with most of George's insinuating questions by pointing to the complete lack of context; his other question is answered already in the post (yes, I'm still a trustee).

But back to the point of the post: Implementing part of a complex law, as Raleigh chose to do, has real repercussions for healthcare providers and patients. That's true whether or not you like the law in the first place.

Beyond that, I think it's a good thing for a healthcare CEO to join the public conversation about that vital and complex industry. CH is doing some good things in our community, and as community health becomes a bigger issue, so will communication.

That’s nearly $60 million more than the year before. How can we keep that up?

The ACA has indeed made life more difficult for most.

But the "need" to expand Medicaid is a result of the fact that the ACA does not actually serve its purported purpose ... to get people on insurance. In fact the ACA has proven to be much more effective at getting people off of health insurance than it has at getting the uninsured insured.

If the ACA worked we would not hear calls for Medicaid expansion, but rather triumphant calls for its reduction. Indeed we would be enjoying a kind of "peace dividend" in regard to Medicaid.

That Democrats argue that we need Medicaid expansion is evidence that the ACA is failing.

Nope. In the most recent Gallup poll on the subject, 64% of respondents said they're unaffected by the ACA. Only 18% said they'd been harmed by the law. It would be more accurate to say that "the ACA has indeed made no difference to most."

The Gallup article notes that "Americans' overall approval of the law and expectations for its long-term effects on the healthcare system continue to be strongly related to their party affiliation." That is, opposition to the ACA is about politics, not actual experience with the law's provisions.

"The 'need' to expand Medicaid is a result of the fact that the ACA does not actually serve its purported purpose."

Nope. Many others who don't understand the law and are ignorant of its provisions have made this claim. Medicaid expansion was always part of the ACA. It makes no sense to talk about the ACA without Medicaid expansion, and while the SCOTUS decision obviously changed that in implementation, it didn't change the law's intent.

You can argue that the health insurance reform should not have included Medicaid, but that's the way it was designed from the start, so your critique as stated makes no sense.

Yes, it was designed such that it's failure would be absorbed by Medicaid. Fortunately most states have rejected Medicaid expansion and in doing so have exposed that the ACA does not deliver on higher rates of insured Americans.

But some good news is that according to a NY Times/Kaiser poll, three southern states demonstrated they would rather improve the ACA than repeal it. 60 percent in NC held this position. http://www.nytimes.com/2014/04/24/health/health-law-repeal-has-little-support-poll-finds.html?_r=0

The state counts I see show 18-21 no, 26-27 yes, and the rest considering expansion. So while just over half have accepted, it doesn't follow that nearly half have rejected. It would be accurate to say that nearly half have not expanded at this point.

Interesting article. Attitudes are shifting and the repealers may be boxing themselves in.

WH spin: "Nearly half of states are so locked into the politics of Obamacare that they're willing to leave nearly 5.7 million of their own people uninsured. Take a look at our map -- and make sure you share it."

Here's another take that uses the perhaps-more-accurate "considering expansion" and "not expanding coverage at this time" instead of the WH's "refusing to expand."